"Medicine is a social science, and politics is nothing else but medicine on a large scale"—Rudolf Virchow

May 25, 2015

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals about active public health threats. This issue covers the period from 17 to 23 May 2015, including updates on Middle East respiratory syndrome – coronavirus (MERS-CoV) and seasonal influenza.

Middle East respiratory syndrome – coronavirus (MERS-CoV)

Since April 2012 and as of 21 May 2015, 1 152 cases of MERS-CoV have been reported by local health authorities worldwide, including 471 deaths. Since the last update on 13 May, Saudi Arabia has reported six additional cases of MERS-CoV infection and six deaths in previously reported cases.

On 20 May 2015, the South Korean Centers for Disease Control and Prevention reported a case of MERS-CoV in a 68-year-old man, who worked in Bahrain from 18 April until 3 May 2015 in crop farming. On 21 May 2015, the South Korean Centers for Disease Control and Prevention confirmed two additional cases resulting from contact to the case reported on 20 May. Currently 64 people who have been in contact with the cases are being monitored for 14 days.

Seasonal influenza

Low intensity of influenza activity was reported by 40 countries. Weekly reporting for the 2014–15 influenza season ends this week and will resume in week 40 for the 2015–16 season. In summer, reporting will continue monthly.

May 15, 2015

Every morning since the first of two recent earthquakes struck Nepal on 25 April, Dr Sharmila Shrestha and researcher Sanjita Thapa have made the hour-long journey from Kathmandu to Kavrepulanchok, a district east of Kathmandu valley, with one goal in mind – to protect people against disease outbreaks.

Following the buckled Araniko Highway toward the hilltop town of Dhulikhel, the district headquarters, the pair pick up Chief District Health Officer Rajendra Prasad Shaha before arriving at the district health office for their morning meeting.

Amid the pleasantries, the strength of their working relationship – which predates the recent disaster – is clear. Such ties are proving critical to addressing immediate public health challenges, including monitoring and controlling communicable diseases, such as diarrhoeal disease, seasonal flu and upper respiratory tract infection. There is a heightened risk of outbreaks following the first and subsequent 12 May earthquakes due to disruption of shelter, water and sanitation, as well as the coming rainy season.

“Before the earthquakes I was a WHO surveillance medical officer monitoring routine immunization drives in four districts. Now I am focusing on one district, Kavre, which I visit daily” says Dr Shrestha, who now works for the WHO supporting the Ministry of Health and Population’s (MoHP) Emergency Disease Surveillance programme (EDS).

The EDS programme monitors the 14 most affected districts, using nine surveillance medical officers from pre-existing WHO monitoring programmes in Nepal, in addition to five Nepali staff drafted in from WHO offices around the world.

According to Dr Shrestha, familiarity with the “zero-reporting strategy,” first implemented in Nepal as a result of WHO’s worldwide polio eradication campaign that began in 1988, has allowed authorities to gain daily intelligence on disease prevalence in outlying areas since the earthquakes. Though cases of communicable diseases have been documented, an outbreak has not yet occurred.

“Zero reporting means that every ward, every day, must report to the district office on each and every case they have received during that day. If no cases have been received, then they must still report,” says Dr Shrestha. “If there are any issues, the local authorities can then investigate.”

April 28, 2015

Influenza activity continued to decrease in most reporting countries, and the proportion of positive specimens from sentinel sources decreased from 28% for week 15 to 25% for week 16. Low intensity of influenza activity was reported by 31 of 37 reporting countries. The number of hospitalised influenza cases is returning to low levels.

ECDC and WHO jointly produce the Flu News Europe bulletin weekly.

Avian influenza

As of 18 April 2015, Egypt has reported 140 human cases of influenza A(H5N1), including 39 deaths in 2015. Since December 2014, Canada and the United States of America have detected several outbreaks of Highly Pathogenic Avian Influenza (HPAI) in wild and domestic birds due to new reassortants of H5 influenza viruses. These viruses are genetically different from the avian influenza A(H5N1) that has caused human infections with high mortality in many countries. To date, there have been no reported human infections with this new reassortant virus. The risk to people from these HPAI H5 infections in wild birds, backyard flocks and commercial poultry is considered to be low.

ECDC published a Rapid Risk Assessment on Influenza A(H5N1) in Egypt on 13 March 2015 and an epidemiological update about Influenza A(H5N1) in Egypt on 10 April 2015.

Ebola virus disease in West Africa

As of 21 April 2015, WHO reported 26 074 cases of Ebola virus disease related to the outbreak in West Africa, including 10 820 deaths. Thirty-three new confirmed cases of EVD were reported in the week from 13 to 19 April from Guinea (21 cases) and Sierra Leone (12 cases). Liberia reported no new confirmed cases. If no new cases occur Liberia will be declared Ebola free on 9 May.

The proportion of influenza-virus positive specimens from sentinel sources decreased from 36% in week 14 to 28% in week 15.

ECDC and WHO produce the Flu News Europe bulletin weekly.

Ebola virus disease in West Africa

The downward trend continues in the three affected countries.

Thirty-seven new confirmed cases of Ebola virus disease were reported from WHO in the week from 6 April to 12 April (28 in Guinea and nine in Sierra Leone). Liberia reported no new confirmed cases. Although surveillance is improving in Guinea, unknown chains of transmission remain a source of new infections. The downward trend in Sierra Leone continues although challenges remain.

ECDC published an updated rapid risk assessment on 15 April 2015.

Influenza A(H7N9) – China

Additional 20 cases reported from China.

Since the last update on 11 March 2015, WHO reported 20 additional laboratory-confirmed cases of human infection with avian influenza A (H7N9) virus, including 4 deaths, in China. Cases were reported from five provinces: Anhui (3), Fujian (2), Guangdong (4), Shandong (1), and Zhejiang (10).

April 13, 2015

According to the Ministry of Health and Population of Egypt, as of 6 April 2015, there have been 134 human cases of influenza A(H5N1), including 38 deaths, reported in Egypt so far in 2015. This outbreak in Egypt has now caused more cases during one season than has been reported from any other country globally.

The influenza A(H5N1) virus, commonly known as bird flu, is fatal in about 60% of human infections.

ECDC published an epidemiological update on 10 April and a Rapid Risk Assessment covering A(H5N1) in Egypt on 13 March 2015.

Ebola virus disease epidemic – West Africa

Thirty new confirmed cases of Ebola virus disease were reported from WHO in the week from 30 March to 5 April (21 in Guinea and 9 in Sierra Leone). Liberia reported no new confirmed cases. This is the lowest weekly total since the third week of May 2014.

As of 7 April 2015, WHO reported 25 567 cases of Ebola virus disease related to the outbreak in West Africa, including 10 599 deaths.

ECDC published a Rapid Risk Assessment on 4 February 2015 and provides an epidemiological situation update on a weekly basis.

Seasonal influenza – Europe

During week 14/2015, seasonal influenza activity continued to decrease in most reporting countries, although the proportion of influenza-virus-positive specimens remained high (36%). Since week 51/2014, the positivity rate has been over the threshold of 10% indicating seasonal influenza activity.

ECDC and WHO monitor and report on influenza activity in Europe on a weekly basis throughout the flu season in the Flu News Europe bulletin.

In the week leading to 29 March, WHO reported 82 new confirmed cases of Ebola virus disease, compared with 79 cases the previous week. Fifty-seven new cases were reported from Guinea and 25 from Sierra Leone. No cases were reported from Liberia. The geographic area of transmission also increased, especially in Guinea where seven prefectures reported cases, compared to three in the previous week.

As of 29 March 2015, WHO reported 25 213 cases of Ebola virus disease related to the outbreak in West Africa, including 10 460 deaths. ECDC published a rapid risk assessment on 4 February 2015.

Seasonal influenza 2014–15

Influenza activity is decreasing in most reporting countries but the proportion of influenza virus positive samples remains high (37%). Hospitalized influenza cases were reported mainly among people aged 65 years and above (52%). ECDC and WHO monitor and report on influenza activity in Europe on a weekly basis throughout the flu season in theFlu News Europe bulletin.

Middle East respiratory syndrome coronavirus (MERS-CoV)

Since the last update on 24 March 2015, Saudi Arabia has reported eight additional cases of MERS-CoV infections. The cases were reported from Jeddah (3), Makkah (1), Riyadh (1), Ehssa (1), Eastern Province (1) and Tabuk (1). Since April 2012 and as of 2 April 2015, 1 118 cases of MERS-CoV have been reported by local health authorities worldwide, including 458 deaths. ECDC published its latest rapid risk assessment on 10 March.

The Centre for Health Protection (CHP) of the Department of Health today (March 30) reported the latest surveillance data of the winter influenza season, and again urged the public to heighten vigilance and get vaccinated early against seasonal influenza.

Regarding severe cases, from noon yesterday (March 29) to noon today, three additional cases of influenza-associated admission to intensive care units or death (including one death) among adults aged 18 or above had been recorded under the enhanced surveillance in collaboration with public and private hospitals reactivated since January 2, bringing the total to 579 (436 deaths) so far. Among them, 548 were A(H3N2), eight were A(H1N1)pdm09, six were A pending subtype and 17 were B. In the last winter season in early 2014, 266 cases (133 deaths) were filed.

Last week (from March 22 to 28), 32 cases (23 deaths) were recorded. Separately, a daily average of 4.0 cases (3.0 deaths) were filed in the last seven days (from March 23 to 29), compared with 5.4 cases (3.6 deaths) in the preceding seven days (from March 16 to 22).

Meanwhile, no additional cases of severe paediatric influenza-associated complications or death among children aged under 18 have been reported since yesterday via the ongoing reporting system. The total this year remains 18 (one death) and all were A(H3N2). In 2014, 27 cases (four deaths) were filed.

March 26, 2015

The Centre for Health Protection (CHP) of the Department of Health today (March 26) reported the latest surveillance data of the winter influenza season, and again urged the public to heighten vigilance and get vaccinated early against seasonal influenza.

Regarding severe cases, from noon yesterday (March 25) to noon today, four additional cases of influenza-associated admission to intensive care units or death, including three deaths, among adults aged 18 or above had been recorded under the enhanced surveillance in collaboration with public and private hospitals reactivated since January 2, bringing the total to 569 (427 deaths) so far. Among them, 536 were A(H3N2), eight were A(H1N1)pdm09, eight were A pending subtype and 17 were B. In the last winter season in early 2014, 266 cases (133 deaths) were filed.

Last week (from March 15 to 21), 38 cases (25 deaths) were recorded. Separately, a daily average of 5.1 cases (3.1 deaths) were filed in the last seven days (from March 19 to 25), compared with 5.7 cases (4.6 deaths) in the preceding seven days (from March 12 to 18).

Meanwhile, no additional cases of severe paediatric influenza-associated complication or death among children aged under 18 have been reported since yesterday via the ongoing reporting system and the total this year hence remains at 18, including one death, and all were A(H3N2). In 2014, 27 cases (four deaths) were filed.

March 24, 2015

​The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals about active public health threats. This issue covers the period 15 to 21 March 2015 and includes updates on seasonal influenza, Ebola Virus Disease and Middle East respiratory syndrome coronavirus.

Seasonal influenza

While the proportion of influenza virus positive samples is similar to the previous week (41%), the overall number of influenza detections further decreased. Influenza A(H1N1)pdm09, A(H3N2) and type B viruses continued to circulate in the European Region, with an increasing proportion of type B viruses.

As of 17 March 2015, WHO reported 24 778 cases of Ebola virus disease (EVD) related to the outbreak in West Africa, including 10 231 deaths.

WHO reported 150 new confirmed cases of Ebola in the week up to 15 March, compared with 116 in the previous week. There were 95 new confirmed cases reported in Guinea: the highest weekly total for the country in 2015. Sierra Leone reported 55 new confirmed cases over the same period: the country’s lowest weekly total since late June 2014. As of 17 March, Liberia had not reported new confirmed cases for the third consecutive week.

Middle East respiratory syndrome – coronavirus (MERS CoV)

Since the last update of 12 March 2015, Saudi Arabia has reported 10 additional cases of MERS-CoV in Riyadh (7 cases), Tabuk (1) and Eastern Province (2). One of the cases was a healthcare worker and one reported animal contact. Since April 2012, 1 103 cases of MERS-CoV have been reported by local health authorities worldwide, including 454 deaths. To date, all cases have either occurred in the Middle East, have direct links to a primary case infected in the Middle East, or have returned from this area.

ECDC published an update of its rapid risk assessment on MERS-CoV on 9 March 2015.

Since December 2014 and up to February 2015, the weekly number of excess deaths from all-causes among individuals ≥ 65 years of age in 14 European countries have been significantly higher than in the four previous winter seasons. The rise in unspecified excess mortality coincides with increased proportion of influenza detection in the European influenza surveillance schemes with a main predominance of influenza A(H3N2) viruses seen throughout Europe in the current season, though cold snaps and other respiratory infections may also have had an effect.

It would be interesting to see a comparable study of excess mortality in Hong Kong and mainland China; Hong Kong has certainly seen many influenza deaths this winter, and I post the CHP surveillance reports because I assume the rest of China is dealing with similar numbers.

For that matter, I'd love to see such a study about eastern Canada and the northeastern US during the same months. While most of us have been basking in the warmest winter since records began in 1888, eastern Canada and much of New England have been in a very bad cold snap indeed.